Evaluation of the Families Matter! Program in Tanzania: An Intervention to Promote Effective Parent-Child Communication About Sex, Sexuality, and Sexual Risk Reduction

Evaluating a youth-designed sexual and reproductive health mass and social media campaign in Côte d'Ivoire: triangulation of three independent evaluations

Merci Mon Héros (MMH) is a youth-designed multi-media campaign seeking to improve sexual and reproductive health and family planning (SRH/FP) outcomes among youth living in nine francophone countries. A mixed methods approach was implemented to assess the MMH campaign progress and impact in Côte d'Ivoire. Three data sources were triangulated to evaluate the campaign: social media listening (October 2019-January 2021); a quantitative cross-sectional monitoring survey (September 2020) with 412 youth (aged 16-24) and 597 adults (aged 25-49); and a qualitative study using a Most Significant Change approach (March 2021), including a total of 24 focus group discussions with youth (aged 15-24) and adults (aged 25+) exposed to the MMH campaign. Data from all three studies were analysed independently and then brought together through a triangulation workshop where the study team compared findings to achieve convergence in evaluation results. Social listening results showed topic-specific online conversations related to MMH campaign spiked significantly during the two-week period after topic-specific campaign posts (p < .05), suggesting potential campaign impact. Survey results showed both adults and youth were more likely to have spoken with someone about FP in the past five months if exposed to the campaign (p < 0.01). Qualitative findings support the campaign's effect on shifting attitudes and behavioural uptake of intergenerational communication among adults and youth. This evaluation shows evidence of MMH's strong potential for impact in encouraging communication and the need to focus efforts on strategies to strengthen supportive adults' communication competencies and redefine what it means to act in support of SRH/FP for youth.

Strong Father-Child Relationships and Other Positive Childhood Experiences, Adverse Childhood Experiences, and Sexual Risk Factors for HIV among Young Adults Aged 19-24 Years, Namibia, 2019: A Cross-Sectional Study

Using cross-sectional data from the 2019 Namibia Violence Against Children and Youth Survey and sex-stratified multivariable models, we assessed the associations between four different positive childhood experiences (PCEs) and having ≥3 adverse childhood experiences (ACEs), including ≥3 ACE-PCE interaction terms, and seven sexual risk factors for HIV acquisition among young adults aged 19-24 years. One PCE, having a strong father-child relationship, was inversely associated with two risk factors among women (lifetime transactional sex (OR, 0.4; 95% CI, 0.2-0.7) and recent age-disparate sexual relationships (OR, 0.3; 95% CI, 0.2-0.5)), and significantly interacted with having ≥3 ACEs for three risk factors among women (not knowing a partner's HIV status, infrequently using condoms, and ever having an STI) and one among men (having multiple sexual partners in the past year). The other PCEs were significantly associated with ≤1 HIV risk factor and had no significant interaction terms. Strong father-child relationships may reduce HIV acquisition risk and mitigate the effect of childhood adversity on HIV risk among young adults in Namibia.

Reaching Youth Through Faith Leaders: Evaluation of the Faith Matters! Initiative

Faith leaders can be uniquely positioned to guide and support young people on health issues, particularly HIV/AIDS and sexual violence. Faith Matters!, a 2-day training workshop for faith leaders, was delivered in September 2021 in Zambia. Sixty-six faith leaders completed a questionnaire at baseline, 64 at posttraining, and 59 at 3-month follow-up. Participants' knowledge, beliefs, and comfort communicating about HIV/AIDS and sexual violence were assessed. More faith leaders accurately identified common places where sexual violence occurs at the 3-month point compared to baseline: at church (2 vs. 22, p = .000), the fields (16 vs. 29, p = .004), parties (22 vs. 36, p = .001), and clubs (24 vs. 35, p = .034). More faith leaders stated that they engaged in conversations that supported people living with HIV (48 at baseline vs. 53, p = .049 at 3-month follow-up). These findings can inform future HIV/AIDS initiatives focusing on increasing the capacity among communities of faith.

Changing the Script: Intergenerational Communication about Sexual and Reproductive Health in Niamey, Niger

Most strategies to reduce adolescent pregnancies have been designed to educate adolescents directly about family planning (FP), while adolescents often cite peers and parents as their primary sources of sexual health information. Yet parents' lack of knowledge about sexual and reproductive health (SRH), low self-efficacy to initiate conversations, and adverse social norms act as barriers to open intergenerational communication. To better understand the normative environment influencing communication between parents and youth about FP/SRH in francophone West Africa, the USAID supported Breakthrough RESEARCH project conducted a multi-stage qualitative study in Niger. During Stage 1, the research team developed a screening tool (based on a literature review) to categorize research participants into those who practiced open intergenerational communication about FP/SRH, and those who did not. Stage 2 consisted of 40 in-depth interviews with young people (ages 15-24) and adults (≥25 years old), stratified by whether they practiced open intergenerational communication. Results showed restrictive social norms related to youth SRH and access to information and services. However, particularly among participants classified as open-communicators, there is a hierarchy of norms and normative beliefs, with abstinence as the most virtuous decision for youth, but approving communication about and access to SRH services in order to minimize harm. Participants rely on values such as the protection of youth, protection of family honor and promotion of well-being as means to act in counter-normative ways and communicate about FP/SRH. Implications for the field include demystifying and destigmatizing SRH topics, increasing adults' communication skills, and changing the "script" to a more life-affirming view of SRH.

Assessing layered HIV prevention programming: optimizing outcomes for adolescent girls and young women

OBJECTIVE

To assess how exposure to multiple, layered interventions predicts HIV-related outcomes among adolescent girls (15-19 years) and young women (20-24 years) in Kenya.

DESIGN

Survey data from adolescent girls and young women (n = 736) with 14-16 months of engagement with DREAMS, a comprehensive HIV prevention program that provides a range of health education, life skills, social protection, and social and behaviour change interventions.

METHODS

Nonparametric recursive partitioning technique - classification and regression tree (CART) - to identify the best predictors (DREAMS interventions) for achieving the desired HIV-related outcomes (consistent condom use and no transactional sex or sexual violence).

RESULTS

Among adolescent girls, schooling support reduced the likelihood of engaging in transactional sex, whereas schooling support and exposure to parenting program reduced the likelihood experiencing sexual violence. Likelihood of consistent condom use increased among adolescent girls with exposure to preexposure prophylaxis (PrEP), schooling support, and the violence prevention programming. Among young women, multiple pathways reduced the likelihood of engaging in transactional sex: exposure to the male sexual partner program; exposure to the youth fund program; exposure to the violence prevention program; or exposure/engagement with schooling support, parenting programming, and the youth fund program. For young women, consistent condom use increased with schooling support and male partner engagement. Additionally, engagement in violence prevention program and male partner engagement increased the likelihood of not experiencing sexual violence among young women.

CONCLUSION

Exposure to a combination of DREAMS interventions predicted outcomes that can reduce HIV risk among AGYW, though the pathways differed by outcome and age group.

Sexual risk behaviors, mental health outcomes and attitudes supportive of wife-beating associated with childhood transactional sex among adolescent girls and young women: Findings from the Uganda Violence Against Children Survey

Compared to young men, Ugandan young women are disproportionately impacted by HIV. Childhood transactional sex may contribute to this disparity. Using data from the 2015 Uganda Violence Against Children Survey, we used logistic regression models to assess the association between childhood transactional sex and negative outcomes. Among 18-24-year-old young women who had sex prior to 18 (n = 982), those who ever engaged in transactional sex had 5.9 times [adjusted odds ratio (AOR); confidence interval (CI): 1.6–22.2] higher odds of having multiple sexual partners in the past year; 5.2 times (AOR; CI: 2.1–12.9) higher odds of infrequent condom use in the past year; 3.0 times (AOR; CI: 1.2–7.9) higher odds of hurting themselves intentionally; and 3.2 times (AOR; CI: 1.3–7.7) higher odds of having attitudes justifying spousal abuse than young women who never engaged in transactional sex. Interventions for transactional sex and HIV in Uganda should consider prioritizing prevention, harm-reduction and continued investment in adolescent girls’ and young women’s futures.

Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

BACKGROUND

Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question.

METHODS

The study traced adolescents aged 10-19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents.

RESULTS

Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97-0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98-1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92-0.97, p<.0001) and anxiety (0.91, 95% CI 0.89-0.94, p<.0001) symptoms reported by adolescents.

CONCLUSIONS

Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

How far do parenting programmes help change norms underpinning violence against adolescents? Evidence from low and middle-income countries

Recent years have seen an upsurge in parent education programmes in low and middle-income countries (LMICs) that aim to help reduce violence against children. This article draws on a narrative review that examined the impact of 42 programmes working with parents of adolescents in LMICs. Here we focus on 17 initiatives that aimed to reduce neglect of, or physical, emotional or sexual violence against adolescents, or to reduce child marriage. Programmes aiming to prevent sexual violence or child marriage generally focused more strongly on understanding and challenging prevailing norms, while those oriented to preventing physical and emotional violence emphasised sharing information and practising new communication skills. We argue that key elements of programme design (group-based participatory sessions, formative research that enabled sensitive framing and adaptation of content) have strong potential to help shift norms that underpin violence against adolescents. To fulfil their potential to change norms underpinning violence against adolescents, programmes should expand their reach, with a particular focus on embedding initiatives within institutions that can take them to scale, promoting male engagement, and support participants to maintain changes over the long-term.

Integrated Care Delivery for HIV Prevention and Treatment in Adolescent Girls and Young Women in Zambia: Protocol for a Cluster-Randomized Controlled Trial

Background

Among countries in sub-Saharan Africa, Zambia has one of the highest incidences of HIV. Adolescent girls and young women (AGYW) are a particularly affected group because of their social and economic vulnerability.

Objective

The goal of this study is to test a multilevel package of interventions at the community and health system levels in Zambia in order to connect AGYW with a source of regular care, which will in turn allow for sustainable, successful implementation of regular HIV testing and adherence to antiretroviral treatment.

Methods

We will adapt prior tools to create the SHIELD (Support for HIV Integrated Education, Linkages to Care, and Destigmatization) intervention to educate and empower Zambian AGYW of 10-24 years of age and their families and to create community-based youth clubs to foster peer support. We will also develop integrated wellness care clinics to offer a youth-friendly environment that provides tailored clinical services. We will perform formative research, including focus groups and in-depth interviews, among AGYW, caregivers, and stakeholders to help inform the development and tailoring of the interventions. A cluster-randomized controlled trial will be implemented in Lusaka, with six clinic catchment areas randomized into three groups: zones with integrated wellness care clinics and SHIELD intervention, zones with only SHIELD intervention, and control zones with no intervention. We will assess HIV testing among the HIV-negative or unknown (HIV-/u) cohort, and retention in care along with viral load suppression will be evaluated in the HIV-positive (HIV+) cohort. We will use in-depth interviews and surveys to collect staff and stakeholder feedback after the trial. Cost-effectiveness of the interventions and return-on-investment impacts will be quantified using a microsimulation model.

Results

Interim results are expected in 2021, and the final results are expected in 2022. If this multilevel intervention is successful in establishing a comprehensive care continuum for HIV-affected AGYW, the Zambian Ministry of Health may advocate for expansion to additional settings to support national scale-up.

Conclusions

This integrated service delivery model can also be a platform to implement additional preventive services, so HIV-/u and HIV+ AGYW can receive comprehensive, integrated services.

Trial Registration

ClinicalTrials.gov NCT03995953; https://clinicaltrials.gov/ct2/show/NCT03995953

International Registered Report Identifier (IRRID)

PRR1-10.2196/15314

Adolescents' compulsive sexual behavior: The role of parental competence, parents' psychopathology, and quality of parent-child communication about sex

BACKGROUND AND AIMS

Compulsive sexual behavior (CSB) has implications for clinical and non-clinical adult populations. Disposition to CSB has been shown to influence adolescence sexual behaviors, but the development of adolescents' disposition toward CSB has yet to be examined in the family context. In this study, we investigated whether parent-adolescent communication mediates the links between parental characteristics and adolescents' CSB.

METHODS

The sample included 275 Israeli families [triad of mothers (age = 34-63 years, M = 45.48, SD = 5.46), fathers (age = 36-83 years, M = 48.33, SD = 6.63), and one adolescent (48.2% boys, 51.1% girls; age = 14-18 years, M = 16.23, SD = 1.18)]. Parents completed measures of psychopathology, parental self-esteem, and parental self-efficacy, and adolescents completed measures of quality of sex-related communication and CSB.

RESULTS

The results indicate that, for girls, higher maternal self-esteem and lower psychopathology were linked with better sex-related communication and so with lower CSB. For boys, only parental religiosity was linked with the quality of sex-related communication and CSB, with religious parents having better communication than secular ones.

DISCUSSION

The findings provide an opportunity for researchers to gain a better insight into the dynamics of familial factors in the development of CSB among adolescents.